Presentation
Upgaze palsy, neck pain, and worsening headache.
Patient Data
Lobulated isointense T1/T2 signal enhancing pineal region mass with perilesional thalamic and midbrain edema. Small non-enhancing cystic focus on the right. Dorsal midbrain mass effect with effacement of the cerebral aqueduct results in mild hydrocephalus with periventricular high FLAIR signal representing transependymal edema.
HISTOPATHOLOGY
DIAGNOSIS: 1 – 5) Multiple biopsies from a pineal tumor showing a central PINEAL GERMINOMA with surrounding reactive gliotic tissue. No other germ cell elements are seen. Supplementary immunohistochemistry to follow.
SUPPLEMENTARY IMMUNOHISTOCHEMISTRY: Immunohistochemical staining was performed on the best preserved tissue in Biopsy 4. No reactivity is seen with antibodies to beta HCG or alpha fetoprotein. The tumor cells show variable reactivity with antibody to PLAP confirming the diagnosis of pineal germinoma. The reactive lymphoid cells are predominantly T cells with some B cells.
Case Discussion
Parinaud syndrome is a upward gaze palsy caused by superior tectal plate compression. This patient underwent surgical resection of the mass and at 10 year follow-up was disease free.
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